onewikiaorg-20200213-history
Epilepsy - the Bluffer's Guide
'Epilepsy: Patient & Family Sheet' Catherine A Kernich ''The Neurologist ''2003; 9(5):265-6 Epilepsy is a disorder of the brain characterized by recurrent seizures. It is frequently referred to as a seizure disorder. During a seizure, groups of neurons signal abnormally. Neurons are brain cells that generate electrical impulses that act on other neurons, muscles, or glands to produce movement, sensation, thoughts, and feelings. Therefore, the abnormal impulses of a seizure cause a sudden change in behavior. Approximately 2 million people in the United States have epilepsy. This represents one in every 100 people. About 30% of the new cases of epilepsy begin in early childhood or adolescence. There is also a high incidence of newly diagnosed seizures in adults over the age of 65. There are over 30 different types of seizures. Usually a person with epilepsy has only one or two types of seizures. The type of seizure that a person experiences depends on the part of the brain involved and the number of neurons affected. It is important to identify the type of seizures that a person is experiencing. This information guides the treatment prescribed. Certain medications work better for some seizure types than for others. In addition, seizures can be easily mistaken for other health problems including drug or alcohol abuse, stroke, or diabetes. Failure to recognize seizures could delay their treatment. The two main categories of seizures are generalized and partial. In a generalized seizure, abnormal electrical activity occurs in many parts of the brain at the same time. About 40% of people with seizures have generalized seizures. Partial seizures affect only a small part of the brain. The remaining 60% of people with seizures have partial seizures. There are several different types of generalized seizures. Absence seizures, formerly referred to as petit mal seizures, cause a momentary loss of consciousness. The individual may appear to be staring off into space. They are most commonly seen in children. An absence seizure only lasts for seconds and the individual quickly returns to full awareness afterward. Absence seizures may occur frequently throughout the day and can lead to learning problems if not treated. Another type of generalized seizure is the generalized tonic-clonic (GTC) seizure. Many people refer to this type of seizure as a grand mal seizure. GTC seizures usually have two phases. During the tonic phase, the individual experiences sudden muscle stiffening. This is quickly followed by the clonic phase, which is characterized by repeated muscle jerking. The person will loose consciousness, breathing may be shallow or temporarily stopped, and loss of bowel or bladder control may occur. A GTC seizure may last for several minutes. Confusion and fatigue are common after the person has regained consciousness. There are other types of generalized seizures. All may result in temporary loss of consciousness. Tonic seizures involve sudden stiffening of muscles. Clonic seizures involve repeated muscle jerking. Atonic seizures, or drop attacks, are characterized by a sudden loss of muscle tone. The individual may fall to the ground. Atonic seizures may last from 10 seconds to 1 minute, after which the person can stand and walk again. There are two main types of partial seizures. The first is simple partial seizures. During a simple partial seizure, the individual remains conscious and aware of the environment. These seizures take many forms, depending on the area of the brain that is affected. Some individuals with simple partial seizures experience unusual feelings. These might include sudden fear, joy, or sadness. Others may have sudden nausea or stomach pain. Because all of the 5 senses are controlled in the brain, individuals with simple partial seizures may experience sensations that are not real including unusual sounds, strange odors, unpleasant tastes, or visual distortions. Time may seem distorted. The sensation of de´ja` vu, where new places or events seem familiar, may also occur. The individual may experience the opposite sensation, where familiar places and events seem unfamiliar. Simple partial seizures may also cause uncontrolled movements in any part of the body. These movements may include jerking of an extremity, unusual tongue movements, or blinking of the eyes. An onlooker may not be aware that a person is having a seizure. Another type of partial seizure is a complex partial seizure. These seizures may also be referred to as psychomotor or temporal lobe seizures. Symptoms of a complex partial seizure may include strange repetitive behavior such as blinking, facial twitching, chewing, or lip smacking. These behaviors are called automatisms. The individual may also have other behaviors such as unbuttoning or picking at clothing. An individual with complex partial seizures usually has the same set of behaviors with each seizure. A complex partial seizure involves a larger area of the brain than a simple partial seizure. As a result, the individual has a change in level of consciousness often described as a dreamlike state. During the seizure, the individual cannot interact normally with others and may appear dazed. The person may be able to speak but may not make sense or may not respond appropriately. Some people may wander in a confused fashion. If attempts are made to restrain a person during a complex partial seizure, the individual may flail or struggle. The individual usually has no recollection of what happened during a complex partial seizure. These seizures usually last for several seconds to a few minutes. The individual is often confused after the seizure. Another type of seizure is the partial seizure secondarily generalized. This type of seizure starts in a small part of the brain and spreads to the whole brain. The changes in movement or sensation in the partial phase of this seizure type act as a warning of a GTC to follow. This warning is referred to as an aura. There are several different causes of seizures. These include perinatal injury, meningitis, tumors, head trauma, and stroke. People with a family history of seizures have a higher incidence of seizures than the general population. However, in 7 of 10 people with epilepsy, the cause cannot be identified. Epilepsy is diagnosed through medical history and specialized tests. The description of the seizure, including sensations or movements that occurred immediately before and during the seizure, is an important part of the history. Family members can help to describe the seizure. The next step in the diagnosis is an electroencephalogram (EEG). This test detects the electrical activity in the brain. The pattern of electrical activity can identify the seizure type and location of the seizure focus or abnormal neurons in the brain. During the EEG, the physician or technician may induce a seizure through the use of medication or sleep deprivation. This assists the physician in identifying the seizure. The goal of epilepsy treatment is to prevent or decrease the frequency of seizure activity. The main treatment is the use of medications. Your physician will work with you to determine the correct medication or combination of medications to prevent the seizures with the fewest side effects. There are several factors that the physician must consider when developing a medication regime. These include the type, frequency, and severity of seizure; any accompanying medical conditions; other prescribed medications; and the age of the individual. Some people with epilepsy may not have good control of their seizures with medications alone. Other epilepsy treatments including epilepsy surgery and vagus nerve stimulation may be considered. Additional testing is often needed to determine if a person with epilepsy is a candidate for these types of treatments. If you have epilepsy, it is important to inform all of your health care providers and provide them with a list of your medications. In addition, a Medic- Alert bracelet will alert emergency medical personnel that you have epilepsy. These bracelets are available at most pharmacies.